3D Doctor with a briefcase and a stethoscopeWhen I was first diagnosed, in the dark ages, there were NO insulin pumps, NO CGM, NO blood glucose meters, NO HbA1c, NO disposable syringes, NO human recombinant DNA insulin.  Yup, certainly seem hard to believe … almost 50 years ago.

Then came advances:  human insulin, portable (and even tiny) meters, disposable syringes and Lantus, insulin pumps with and without tubing, CGM, A1c … AMAZING and WONDERFUL new techniques and technologies, helping me to live better and longer and with fewer complications.

In all that time, the “doctor’s office” changed too.  Improved?  Jury’s still out on that and much of it depends on where you live, your doctor’s office and staff, and how proactive you are about managing your own health and your medical team.

Here’s what I see … and the caveat is that I live in a large metropolitan county within an hour’s drive of both Los Angeles and San Diego.  Indeed, we are offered top notch and accessible medical services.  But is it better?

I see endocrinologists, mostly in group practices, who manage T1 PWD’s mostly by the lab results and the numbers.  They are busy … very busy.  (there is talk that there will soon be a shortage of internal medicine doctors, not to mention the trickle down to a more severe shortage of internists specializing in endocrine disorders (endocrinologists).  The endos in practice do NOT have a shortage of patients, as there is a horrific boom in the diagnosis of both Type 1 and Type 2 diabetes.  What feels lacking is compassion and a sense of truly caring. 

To handle their large caseload of patients, from my vantage point, they are less personal, give less time and have less direct follow up.  They rely on CDE’s and PA’s, who are often the ones who recommend which pump (depending on their own relationship with the vendors and their comfort with having to know how to work with the many pumps on the market).  They often don’t help the patient understand the full range of options and a choosing process to help them. 

There is at least one website I know of that offers a quiz to help you define your needs in an insulin pump (http://insulinpump.com/Questionnaire?qid=4914) and another quiz to help you decide if the pump is for you (http://insulinpump.com/Thinking-About-Switching).

And, many of them now have assistants … unheard of years ago, as the CDE WAS the assistant to the endo.  Often, the PWD’s first interaction in the office is to the assistant to the CDE who is a separate function from the endo. 

Is that bad?  I’m not sure but I’m beginning to think it depends on how well the office is integrated and how well each piece of the puzzle works independently as well as in concert to help the PWD.  With a great and interactive communication system coordinating a great CDE assistant, a fabulous and open-minded CDE, and an interested and committed endo … that would be the golden ticket. 

There is one more piece of this puzzle: the administrative staff. 

The front desk folks who might even look up and smile, and long stretch, even greet you by name.

The appointment desk folks who also might smile at you and tell you how to follow up if you forgot to ask a question during your appointment

The medicine renewal folks, who might follow up when they receive a request from you and actually place the order in a timely, accurate and cheerful manner with your pharmacy or DME.

What do you think? Would this be an improvement?

Where would you start?

How do you think we, as patients, can influence our own endos to actively maintain a system like this?

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